Presentation Authors: Walter Cazzaniga*, Paolo Capogrosso, Eugenio Ventimiglia, Luca Boeri, Edoardo Pozzi, Francesco Chierigo, Nicolò Schifano, Federico Belladelli, Rani Zuabi, Costantino Abbate, Federico Dehò, Milan, Italy, Vincenzo Mirone, Naples, Italy, Franco Gaboardi, Francesco Montorsi, Andrea Salonia, Milan, Italy
Introduction: The EAU guidelines suggest performing semen culture in case of increased leukocytes in semen. However, the clinical significance of this parameter is controversial. Furthermore, since the possible causative role of infections in determining semen parameters alterations, identifying either acute or chronic infections in men presenting for couple&[prime]s infertility is clinically relevant. We sought to evaluate the prevalence of and the types of bacterial infections in infertile men presenting with neither clinical signs of infections nor an increased number of seminal leukocytes.
Methods: Complete data from 873 consecutive patients seeking medical help for couple&[prime]s infertility, asymptomatic for genital infections and without an increased number of leucocytes at the semen analysis were analysed. Testes volume was assessed through a Prader orchidometer. Health-significant comorbidities were scored by means of the Charlson Comorbidity Index (CCI) (CCI; categorized 0 vs â‰¥1). Semen cultures were obtained from every man, after having ruled out both urethritis and bladder infections. Polymerase chain reaction (PCR) DNA was used to identify Chlamydia trachomatis and Ureaplasma urealyticum in the semen. A concentration of â‰¥103 cfu/mL urinary tract pathogens in the ejaculate was considered suggestive for significant bacteriospermia. Leukocytospermia was defined as more that 10 3 leukocytes in the ejaculate at the semen analysis.
Results: Of 873, 96 (11%) and 777 (89%) men presented a positive and a negative semen culture, respectively. No significant differences in terms of clinical parameters were observed between men with positive or negative semen culture. Total testosterone was lower in the group with positive semen culture despite no leukocytospermia (median 4.6 (IQR 3.5-5.8) vs 3.9 (IQR 3.0 - 5.7); pâ‰¤0.05). The most commonly identified infections were Ureaplasma urealitycum (35%) and Enterococcus faecalis (31%), followed by Staphylococcus aureus (7%), Chlamidya trachomatis (6%), Streptococcus faecalis (4%) and others (17%).
Conclusions: Despite the absence of signs and symptoms of infection, the prevalence of bacterial infection/colonization in the study cohort is relevant. Identifying this condition in asymptomatic infertile men may be helpful to potentially improve semen and sperm quality. Whether our results eventually reflect the presence of a true bacterial infection or an altered testis microbial composition needs to be addressed with further preclinical studies.